Materiały źródłowe

• #1 Vaginitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK470302/

  Vaginitis is inflammation of the vagina, typically caused by infections, hormonal changes, or irritants. The pathophysiology of vaginitis varies by type, but common symptoms include vaginal discharge, itching, burning, and changes in vaginal pH. The specific nature of the discharge and associated symptoms aid in distinguishing between different types of vaginitis. Accurate diagnosis relies on patient history, physical examination, and laboratory testing. Correct diagnosis of vaginitis cannot be accomplished over the phone.[18] […] The vaginal epithelium is a hormone-responsive, nonkeratinized, stratified squamous epithelium. The normal vaginal flora of reproductive-age women includes multiple aerobic, facultative anaerobic, and obligate anaerobic species. Over 50 species of bacteria are normally present in the vagina, with lactobacilli predominating in most women.[3] Anaerobic bacteria dominate aerobes by a ratio of 10:1. The bacteria are symbiotic with the host and can change based on the vaginal microenvironment.[4][5][6] […] Vaginitis can be caused by the overgrowth of bacteria or yeast or an infection with trichomoniasis. In addition, irritants such as harsh soaps, scented hygiene products, and tight clothing may contribute to the development of vaginitis.[10]

• #2 Vaginitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK470302/

  Vaginitis is inflammation of the vagina, typically caused by infections, hormonal changes, or irritants. The pathophysiology of vaginitis varies by type, but common symptoms include vaginal discharge, itching, burning, and changes in vaginal pH. The specific nature of the discharge and associated symptoms aid in distinguishing between different types of vaginitis. Accurate diagnosis relies on patient history, physical examination, and laboratory testing. Correct diagnosis of vaginitis cannot be accomplished over the phone.[18] […] The vaginal epithelium is a hormone-responsive, nonkeratinized, stratified squamous epithelium. The normal vaginal flora of reproductive-age women includes multiple aerobic, facultative anaerobic, and obligate anaerobic species. Over 50 species of bacteria are normally present in the vagina, with lactobacilli predominating in most women.[3] Anaerobic bacteria dominate aerobes by a ratio of 10:1. The bacteria are symbiotic with the host and can change based on the vaginal microenvironment.[4][5][6] […] Vaginitis can be caused by the overgrowth of bacteria or yeast or an infection with trichomoniasis. In addition, irritants such as harsh soaps, scented hygiene products, and tight clothing may contribute to the development of vaginitis.[10]

• #3 Vaginitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK470302/

  Vaginitis is inflammation of the vagina, typically caused by infections, hormonal changes, or irritants. The pathophysiology of vaginitis varies by type, but common symptoms include vaginal discharge, itching, burning, and changes in vaginal pH. The specific nature of the discharge and associated symptoms aid in distinguishing between different types of vaginitis. Accurate diagnosis relies on patient history, physical examination, and laboratory testing. Correct diagnosis of vaginitis cannot be accomplished over the phone.[18] […] The vaginal epithelium is a hormone-responsive, nonkeratinized, stratified squamous epithelium. The normal vaginal flora of reproductive-age women includes multiple aerobic, facultative anaerobic, and obligate anaerobic species. Over 50 species of bacteria are normally present in the vagina, with lactobacilli predominating in most women.[3] Anaerobic bacteria dominate aerobes by a ratio of 10:1. The bacteria are symbiotic with the host and can change based on the vaginal microenvironment.[4][5][6] […] Vaginitis can be caused by the overgrowth of bacteria or yeast or an infection with trichomoniasis. In addition, irritants such as harsh soaps, scented hygiene products, and tight clothing may contribute to the development of vaginitis.[10]

• #4 Pathogenesis of Bacterial Vaginosis: Discussion of Current Hypotheses

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4957507/

  In April 2015, the Division of Microbiology and Infectious Diseases of the National Institute of Allergy and Infectious Diseases hosted an experts technical consultation on bacterial vaginosis (BV), where data regarding controversies over the pathogenesis of BV were discussed. […] Despite its public health importance, however, the pathogenesis of BV remains unclear, so much so that some refer to this condition not as an infection but rather as a dysbiosis, a microbial imbalance in the vaginal flora that can precipitate changes in the normal activities of the vagina. […] There is agreement that the shift away from an optimal vaginal flora consisting of lactobacilli is the biological risk factor for associated adverse outcomes of BV. Disagreement exists, however, as to how this change comes about—is it the introduction of single or multiple pathogens or do other factors lead to the overgrowth of BV-associated anaerobes? Determining the trigger for the development of BV is crucial to improving the treatment, management, and prevention of this important condition.

• #5 Vaginitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK470302/

  Vaginitis is inflammation of the vagina, typically caused by infections, hormonal changes, or irritants. The pathophysiology of vaginitis varies by type, but common symptoms include vaginal discharge, itching, burning, and changes in vaginal pH. The specific nature of the discharge and associated symptoms aid in distinguishing between different types of vaginitis. Accurate diagnosis relies on patient history, physical examination, and laboratory testing. Correct diagnosis of vaginitis cannot be accomplished over the phone.[18] […] The vaginal epithelium is a hormone-responsive, nonkeratinized, stratified squamous epithelium. The normal vaginal flora of reproductive-age women includes multiple aerobic, facultative anaerobic, and obligate anaerobic species. Over 50 species of bacteria are normally present in the vagina, with lactobacilli predominating in most women.[3] Anaerobic bacteria dominate aerobes by a ratio of 10:1. The bacteria are symbiotic with the host and can change based on the vaginal microenvironment.[4][5][6] […] Vaginitis can be caused by the overgrowth of bacteria or yeast or an infection with trichomoniasis. In addition, irritants such as harsh soaps, scented hygiene products, and tight clothing may contribute to the development of vaginitis.[10]

• #6 Vaginitis: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/257141-overview

  A complex and intricate balance of microorganisms maintains the normal vaginal flora. Important organisms include lactobacilli, corynebacteria, and yeast. […] The normal postmenarchal and premenopausal vaginal pH is 3.8-4.2. At this pH, growth of pathogenic organisms usually is inhibited. Disturbance of the normal vaginal pH can alter the vaginal flora, leading to overgrowth of pathogens. […] Loss of vaginal lactobacilli appears to be the primary factor in the changes leading to bacterial vaginosis. Recurrences of vaginitis are associated with a failure to establish a healthy vaginal microflora dominated by lactobacilli.

• #7 Diagnosis of Vaginitis | AAFP

  https://www.aafp.org/pubs/afp/issues/2000/0901/p1095.html

  Vaginitis develops when the vaginal flora has been altered by introduction of a pathogen or by changes in the vaginal environment that allow pathogens to proliferate. […] The normal vaginal environment is characterized by a dynamic interrelationship between Lactobacillus acidophilus and other endogenous flora, estrogen, glycogen, vaginal pH and metabolic by-products of flora and pathogens. Lactobacillus acidophilus produces hydrogen peroxide, which is toxic to pathogens and keeps the healthy vaginal pH between 3.8 and 4.2. Vaginitis occurs because the vaginal flora has been altered by the introduction of pathogens or changes in the vaginal environment that allow pathogens to proliferate. […] In bacterial vaginosis, it is believed that some inciting event decreases the number of hydrogen peroxide-producing Lactobacillus acidophilus organisms. The resultant change in pH allows proliferation of organisms that are normally suppressed, such as Gardnerella vaginalis, Mycoplasma hominis and Mobiluncus species. These organisms produce metabolic byproducts, such as amines, that further increase the vaginal pH and cause exfoliation of vaginal epithelial cells.

• #8 Diagnosis of Vaginitis | AAFP

  https://www.aafp.org/pubs/afp/issues/2000/0901/p1095.html

  Vaginitis develops when the vaginal flora has been altered by introduction of a pathogen or by changes in the vaginal environment that allow pathogens to proliferate. […] The normal vaginal environment is characterized by a dynamic interrelationship between Lactobacillus acidophilus and other endogenous flora, estrogen, glycogen, vaginal pH and metabolic by-products of flora and pathogens. Lactobacillus acidophilus produces hydrogen peroxide, which is toxic to pathogens and keeps the healthy vaginal pH between 3.8 and 4.2. Vaginitis occurs because the vaginal flora has been altered by the introduction of pathogens or changes in the vaginal environment that allow pathogens to proliferate. […] In bacterial vaginosis, it is believed that some inciting event decreases the number of hydrogen peroxide-producing Lactobacillus acidophilus organisms. The resultant change in pH allows proliferation of organisms that are normally suppressed, such as Gardnerella vaginalis, Mycoplasma hominis and Mobiluncus species. These organisms produce metabolic byproducts, such as amines, that further increase the vaginal pH and cause exfoliation of vaginal epithelial cells.

• #9 Vaginal pH Value for Clinical Diagnosis and Treatment of Common Vaginitis

  https://www.mdpi.com/2075-4418/11/11/1996

  In modern society, 75% of all women worldwide have had vaginitis at least once in their lives. […] An imbalance in that ecosystem can alter the vaginal pH and tip the scale to the point of causing issues, such as vaginitis, that require medical attention. […] The most common causes of vaginitis include bacterial vaginosis, trichomoniasis, and vulvovaginal candidiasis. […] The common vaginal microbiome, the Lactobacilli species, can produce acidic pH and bacteriocins to kill other bacteria in the vagina. […] If these normal flora such as Lactobacilli are absent or significantly reduced, the vaginal ecosystem will become imbalanced, and other microorganism or bacteria inside vagina may become overgrown, leading to vaginitis. […] Vaginitis has different types, including bacterial vaginosis (BV), vaginal candidiasis, trichomoniasis, and aerobic vaginitis.

• #10 Infectious Vaginitis | GLOWM

  https://www.glowm.com/section-view/heading/Infectious%20Vaginitis/item/26

  Vaginal discharge is mainly composed of water with electrolytes, microorganisms, epithelial cells, and organic compounds such as fatty acids, proteins, and carbohydrates. Estrogen and the pH are two important factors that influence the types of bacteria present in the vaginal flora. Vaginal lactic acid content provides an acidic pH of less than 4.5 in adult women. Lactic acid is produced from the metabolism of Lactobacillus and by vaginal epithelial cells through the breakdown of glycogen. The low pH favors the growth of acidophilic organisms such as Lactobacillus, but it inhibits the growth of most other bacteria. Lactobacillus appears central in limiting the growth of other bacteria. The combination of a halide ion such as chloride present in abundance in the vagina with peroxidase, present in endometrial and vaginal fluid, and H2O2 produced by certain strains of Lactobacillus forms a potent inhibiting system for certain bacteria in the vagina and of HIV and other virus in vitro. […]

• #11 Diagnosis of Vaginitis | AAFP

  https://www.aafp.org/pubs/afp/issues/2000/0901/p1095.html

  Vaginitis develops when the vaginal flora has been altered by introduction of a pathogen or by changes in the vaginal environment that allow pathogens to proliferate. […] The normal vaginal environment is characterized by a dynamic interrelationship between Lactobacillus acidophilus and other endogenous flora, estrogen, glycogen, vaginal pH and metabolic by-products of flora and pathogens. Lactobacillus acidophilus produces hydrogen peroxide, which is toxic to pathogens and keeps the healthy vaginal pH between 3.8 and 4.2. Vaginitis occurs because the vaginal flora has been altered by the introduction of pathogens or changes in the vaginal environment that allow pathogens to proliferate. […] In bacterial vaginosis, it is believed that some inciting event decreases the number of hydrogen peroxide-producing Lactobacillus acidophilus organisms. The resultant change in pH allows proliferation of organisms that are normally suppressed, such as Gardnerella vaginalis, Mycoplasma hominis and Mobiluncus species. These organisms produce metabolic byproducts, such as amines, that further increase the vaginal pH and cause exfoliation of vaginal epithelial cells.

• #12 Pathogenesis of Bacterial Vaginosis: Discussion of Current Hypotheses

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4957507/

  In April 2015, the Division of Microbiology and Infectious Diseases of the National Institute of Allergy and Infectious Diseases hosted an experts technical consultation on bacterial vaginosis (BV), where data regarding controversies over the pathogenesis of BV were discussed. […] Despite its public health importance, however, the pathogenesis of BV remains unclear, so much so that some refer to this condition not as an infection but rather as a dysbiosis, a microbial imbalance in the vaginal flora that can precipitate changes in the normal activities of the vagina. […] There is agreement that the shift away from an optimal vaginal flora consisting of lactobacilli is the biological risk factor for associated adverse outcomes of BV. Disagreement exists, however, as to how this change comes about—is it the introduction of single or multiple pathogens or do other factors lead to the overgrowth of BV-associated anaerobes? Determining the trigger for the development of BV is crucial to improving the treatment, management, and prevention of this important condition.

• #13 Diagnosis of Vaginitis | AAFP

  https://www.aafp.org/pubs/afp/issues/2000/0901/p1095.html

  Vaginitis develops when the vaginal flora has been altered by introduction of a pathogen or by changes in the vaginal environment that allow pathogens to proliferate. […] The normal vaginal environment is characterized by a dynamic interrelationship between Lactobacillus acidophilus and other endogenous flora, estrogen, glycogen, vaginal pH and metabolic by-products of flora and pathogens. Lactobacillus acidophilus produces hydrogen peroxide, which is toxic to pathogens and keeps the healthy vaginal pH between 3.8 and 4.2. Vaginitis occurs because the vaginal flora has been altered by the introduction of pathogens or changes in the vaginal environment that allow pathogens to proliferate. […] In bacterial vaginosis, it is believed that some inciting event decreases the number of hydrogen peroxide-producing Lactobacillus acidophilus organisms. The resultant change in pH allows proliferation of organisms that are normally suppressed, such as Gardnerella vaginalis, Mycoplasma hominis and Mobiluncus species. These organisms produce metabolic byproducts, such as amines, that further increase the vaginal pH and cause exfoliation of vaginal epithelial cells.

• #14 Diagnosis of Vaginitis | AAFP

  https://www.aafp.org/pubs/afp/issues/2000/0901/p1095.html

  Vaginitis develops when the vaginal flora has been altered by introduction of a pathogen or by changes in the vaginal environment that allow pathogens to proliferate. […] The normal vaginal environment is characterized by a dynamic interrelationship between Lactobacillus acidophilus and other endogenous flora, estrogen, glycogen, vaginal pH and metabolic by-products of flora and pathogens. Lactobacillus acidophilus produces hydrogen peroxide, which is toxic to pathogens and keeps the healthy vaginal pH between 3.8 and 4.2. Vaginitis occurs because the vaginal flora has been altered by the introduction of pathogens or changes in the vaginal environment that allow pathogens to proliferate. […] In bacterial vaginosis, it is believed that some inciting event decreases the number of hydrogen peroxide-producing Lactobacillus acidophilus organisms. The resultant change in pH allows proliferation of organisms that are normally suppressed, such as Gardnerella vaginalis, Mycoplasma hominis and Mobiluncus species. These organisms produce metabolic byproducts, such as amines, that further increase the vaginal pH and cause exfoliation of vaginal epithelial cells.

• #15 Bacterial Vaginosis: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/254342-overview

  In BV, the vaginal flora becomes altered through known and unknown mechanisms, causing an increase in the local pH. […] Lactobacilli are large rod-shaped organisms that help maintain the acidic pH of healthy vaginas and inhibit other anaerobic microorganisms through elaboration of hydrogen peroxide. […] In BV, the lactobacilli population is reduced greatly, while populations of various anaerobes and G vaginalis are increased. […] G vaginalis forms a biofilm in the vagina. […] This predominant G vaginalis biofilm has been shown to survive in hydrogen peroxide (H2 O2), lactic acid, and high levels of antibiotics. […] Fredricks’ study confirms the polymicrobial nature of BV and the presence of G vaginalis as one of the causative agents. […] More recent studies indicated that BV is associated with changes in select soluble immune mediators, an increase in HIV target cells, and a reduction in endogenous antimicrobial activity, which may contribute to the increased risk of HIV acquisition.

• #16 Bacterial Vaginosis: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/254342-overview

  In BV, the vaginal flora becomes altered through known and unknown mechanisms, causing an increase in the local pH. […] Lactobacilli are large rod-shaped organisms that help maintain the acidic pH of healthy vaginas and inhibit other anaerobic microorganisms through elaboration of hydrogen peroxide. […] In BV, the lactobacilli population is reduced greatly, while populations of various anaerobes and G vaginalis are increased. […] G vaginalis forms a biofilm in the vagina. […] This predominant G vaginalis biofilm has been shown to survive in hydrogen peroxide (H2 O2), lactic acid, and high levels of antibiotics. […] Fredricks’ study confirms the polymicrobial nature of BV and the presence of G vaginalis as one of the causative agents. […] More recent studies indicated that BV is associated with changes in select soluble immune mediators, an increase in HIV target cells, and a reduction in endogenous antimicrobial activity, which may contribute to the increased risk of HIV acquisition.

• #17 Core Concepts – Vaginitis – Self-Study Lessons – National STD Curriculum

  https://www.std.uw.edu/go/comprehensive-study/vaginitis/core-concept/all

  Current understanding of the pathogenesis of bacterial vaginosis suggests loss of normal Lactobacillus species in the vagina by multiple facultative and strict anaerobic bacteria, which subsequently leads to vaginal dysbiosis and a proinflammatory state. To date, however, the exact etiology of bacterial vaginosis has not been determined, despite extensive research. The following summarizes current step-by-step conceptual models for the pathogenesis of bacterial vaginosis. […] In the baseline state in a healthy vaginal microbiome, protective Lactobacillus species are dominant, and they produce lactic acid from glycogen, a process that maintains a low vaginal pH; this acidic pH environment inhibits the growth of other bacterial species that are normally present in the vagina at very low levels.

• #18 Core Concepts – Vaginitis – Self-Study Lessons – National STD Curriculum

  https://www.std.uw.edu/go/comprehensive-study/vaginitis/core-concept/all

  Current understanding of the pathogenesis of bacterial vaginosis suggests loss of normal Lactobacillus species in the vagina by multiple facultative and strict anaerobic bacteria, which subsequently leads to vaginal dysbiosis and a proinflammatory state. To date, however, the exact etiology of bacterial vaginosis has not been determined, despite extensive research. The following summarizes current step-by-step conceptual models for the pathogenesis of bacterial vaginosis. […] In the baseline state in a healthy vaginal microbiome, protective Lactobacillus species are dominant, and they produce lactic acid from glycogen, a process that maintains a low vaginal pH; this acidic pH environment inhibits the growth of other bacterial species that are normally present in the vagina at very low levels.

• #19 Core Concepts – Vaginitis – Self-Study Lessons – National STD Curriculum

  https://www.std.uw.edu/go/comprehensive-study/vaginitis/core-concept/all

  The process of vaginal dysbiosis usually begins with the colonization of the vagina by a virulent strain of Gardnerella species, typically following sexual exposure; the proliferation of this organism displaces vaginal lactobacilli and creates a biofilm scaffolding conducive to recruiting Prevotella bivia (and other BV-associated bacteria). […] Gardnerella species and P. bivia engage in a synergistic relationship in which proteolysis by Gardnerella species produces amino acids that enhance the growth of P. bivia. In turn, ammonia produced by P. bivia enhances the growth of Gardnerella species. […] Sialidase, produced by both P. bivia and Gardnerella species, promotes the breakdown of the mucin layer of the vaginal epithelium and increases adherence of other strict anaerobes, including Fannyhesseae vaginae, Sneathia species, Megasphaera type I, and others which join the BV biofilm on the upper layers.

• #20 Core Concepts – Vaginitis – Self-Study Lessons – National STD Curriculum

  https://www.std.uw.edu/go/comprehensive-study/vaginitis/core-concept/all

  The process of vaginal dysbiosis usually begins with the colonization of the vagina by a virulent strain of Gardnerella species, typically following sexual exposure; the proliferation of this organism displaces vaginal lactobacilli and creates a biofilm scaffolding conducive to recruiting Prevotella bivia (and other BV-associated bacteria). […] Gardnerella species and P. bivia engage in a synergistic relationship in which proteolysis by Gardnerella species produces amino acids that enhance the growth of P. bivia. In turn, ammonia produced by P. bivia enhances the growth of Gardnerella species. […] Sialidase, produced by both P. bivia and Gardnerella species, promotes the breakdown of the mucin layer of the vaginal epithelium and increases adherence of other strict anaerobes, including Fannyhesseae vaginae, Sneathia species, Megasphaera type I, and others which join the BV biofilm on the upper layers.

• #21 Core Concepts – Vaginitis – Self-Study Lessons – National STD Curriculum

  https://www.std.uw.edu/go/comprehensive-study/vaginitis/core-concept/all

  The process of vaginal dysbiosis usually begins with the colonization of the vagina by a virulent strain of Gardnerella species, typically following sexual exposure; the proliferation of this organism displaces vaginal lactobacilli and creates a biofilm scaffolding conducive to recruiting Prevotella bivia (and other BV-associated bacteria). […] Gardnerella species and P. bivia engage in a synergistic relationship in which proteolysis by Gardnerella species produces amino acids that enhance the growth of P. bivia. In turn, ammonia produced by P. bivia enhances the growth of Gardnerella species. […] Sialidase, produced by both P. bivia and Gardnerella species, promotes the breakdown of the mucin layer of the vaginal epithelium and increases adherence of other strict anaerobes, including Fannyhesseae vaginae, Sneathia species, Megasphaera type I, and others which join the BV biofilm on the upper layers.

• #22 Core Concepts – Vaginitis – Self-Study Lessons – National STD Curriculum

  https://www.std.uw.edu/go/comprehensive-study/vaginitis/core-concept/all

  Fannyhesseae vaginae stimulates a strong host immune response from vaginal epithelial cells, leading to localized cytokine and beta-defensin production. […] Gradually, the healthy normal dominant vaginal lactobacilli are replaced by Gardnerella species, F. vaginae, bacterial vaginosis-associated bacteria-2 (BVAB-2), Sneathia species, Megasphaera type I, and other BV-associated bacteria. […] In the final phase of this transition to bacterial vaginosis, mucus degradation occurs, the vaginal pH is elevated, and multiple harmful compounds are produced (biogenic amines, toxic metabolites, and proinflammatory cytokines) all resulting in a final state of vaginal dysbiosis and inflammation, which may progress to cause vaginal symptoms and adverse outcomes associated with this infection.

• #23 Core Concepts – Vaginitis – Self-Study Lessons – National STD Curriculum

  https://www.std.uw.edu/go/comprehensive-study/vaginitis/core-concept/all

  Fannyhesseae vaginae stimulates a strong host immune response from vaginal epithelial cells, leading to localized cytokine and beta-defensin production. […] Gradually, the healthy normal dominant vaginal lactobacilli are replaced by Gardnerella species, F. vaginae, bacterial vaginosis-associated bacteria-2 (BVAB-2), Sneathia species, Megasphaera type I, and other BV-associated bacteria. […] In the final phase of this transition to bacterial vaginosis, mucus degradation occurs, the vaginal pH is elevated, and multiple harmful compounds are produced (biogenic amines, toxic metabolites, and proinflammatory cytokines) all resulting in a final state of vaginal dysbiosis and inflammation, which may progress to cause vaginal symptoms and adverse outcomes associated with this infection.

• #24 Core Concepts – Vaginitis – Self-Study Lessons – National STD Curriculum

  https://www.std.uw.edu/go/comprehensive-study/vaginitis/core-concept/all

  Fannyhesseae vaginae stimulates a strong host immune response from vaginal epithelial cells, leading to localized cytokine and beta-defensin production. […] Gradually, the healthy normal dominant vaginal lactobacilli are replaced by Gardnerella species, F. vaginae, bacterial vaginosis-associated bacteria-2 (BVAB-2), Sneathia species, Megasphaera type I, and other BV-associated bacteria. […] In the final phase of this transition to bacterial vaginosis, mucus degradation occurs, the vaginal pH is elevated, and multiple harmful compounds are produced (biogenic amines, toxic metabolites, and proinflammatory cytokines) all resulting in a final state of vaginal dysbiosis and inflammation, which may progress to cause vaginal symptoms and adverse outcomes associated with this infection.

• #25 Pathogenesis of Bacterial Vaginosis: Discussion of Current Hypotheses

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4957507/

  The majority of epidemiologic data support the hypothesis that BV is a STI. […] Assuming that sexual transmission plays a key role in the pathogenesis of BV, the next question concerns the transmitted pathogen(s). […] More recently it was shown that previously unrecognized, unculturable bacteria are also part of the BV flora. […] Although it is highly likely that anaerobes contribute to the symptoms of BV, there has been renewed interest in the hypothesis that G. vaginalis is the inciting pathogen, with studies confirming its virulence factors (ability to adhere to host receptor sites on vaginal epithelial cells, production of cytotoxic substances specific for host cells, and biofilm formation) as well as its concordance in sexual partners. […] In 2014, Schwebke et al presented a conceptual model for the pathogenesis of BV with G. vaginalis as the founder or keystone pathogen.

• #26 Pathogenesis of Bacterial Vaginosis: Discussion of Current Hypotheses

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4957507/

  The majority of epidemiologic data support the hypothesis that BV is a STI. […] Assuming that sexual transmission plays a key role in the pathogenesis of BV, the next question concerns the transmitted pathogen(s). […] More recently it was shown that previously unrecognized, unculturable bacteria are also part of the BV flora. […] Although it is highly likely that anaerobes contribute to the symptoms of BV, there has been renewed interest in the hypothesis that G. vaginalis is the inciting pathogen, with studies confirming its virulence factors (ability to adhere to host receptor sites on vaginal epithelial cells, production of cytotoxic substances specific for host cells, and biofilm formation) as well as its concordance in sexual partners. […] In 2014, Schwebke et al presented a conceptual model for the pathogenesis of BV with G. vaginalis as the founder or keystone pathogen.

• #27 Bacterial Vaginosis and Vulvovaginal Candidiasis Pathophysiologic Interrelationship

  https://www.mdpi.com/2076-2607/12/1/108

  With regard to the second concept that antibiotics predispose to VVC by reducing or eliminating protecting Lactobacillus species, the weakness of this hypothesis is that women with symptomatic BV already demonstrate profound depletion of protective Lactobacillus species well before antibiotics are administered. […] A characteristic consequence of anaerobic proliferation in BV is the increased elaboration of biogenic amines including putrescine, cadaverine, and trimethyl amine oxide responsible for the characteristic malodor observed in women with BV. […] Despite the wide prevalence of BV, there remains an unmet need to better understand the immunologic microenvironment accompanying and driving the dysbiotic state and the contribution of the individual BV-associated species to this environment and disease process. […] The important role of RBV as a dominant contributory factor to VVC recurrence in some subpopulations is underappreciated by practitioners but certainly not by patients.

• #28 Vaginitis, TSS, and other Genitourinary Tract Infections

  https://www.atsu.edu/faculty/chamberlain/website/lectures/lecture/stdd.htm

  Women who have been diagnosed with BV have up to 1,000 times more anaerobic bacteria than women without the disease. […] Instead of the normal predominance of Lactobacillus bacteria, increased numbers of organisms such as Gardnerella vaginalis, Atopobium vaginae, various anaerobes and Mycoplasma hominis are found in the vagina in women with BV. […] The cause of this imbalance in the microflora of the vaginal mucosa is not currently known. […] Overgrowth of Gardnerella vaginalis and other resident anaerobes only partially explains how BV develops. […] The biofilm formed by Gardnerella vaginalis et al., in BV is dense and strongly adherent to the vaginal epithelium. […] The presence of the biofilm enables the bacterial cells to reach higher concentrations (up to 1011 bacteria/mL) than in vaginal fluid and boosts their resistance to both the host immune system and the antimicrobials. […] It has also been shown that Atopobium vaginae is quite resistant to drugs commonly used to treat BV (metronidazole).

• #29 Diagnosis of Vaginitis | AAFP

  https://www.aafp.org/pubs/afp/issues/2000/0901/p1095.html

  Similarly, changes in the vaginal environment, such as an increase in glycogen production in pregnancy or altered estrogen and progesterone levels from the use of oral contraceptives, enhance the adherence of Candida albicans to vaginal epithelial cells and facilitate the germination of yeast. These changes may transform asymptomatic colonization into symptomatic infection. In patients with trichomoniasis, changes in estrogen and progesterone levels, as well as elevations of vaginal pH and glycogen levels, may enhance the growth and virulence of Trichomonas vaginalis.

• #30 Diagnosis of Vaginitis | AAFP

  https://www.aafp.org/pubs/afp/issues/2000/0901/p1095.html

  Similarly, changes in the vaginal environment, such as an increase in glycogen production in pregnancy or altered estrogen and progesterone levels from the use of oral contraceptives, enhance the adherence of Candida albicans to vaginal epithelial cells and facilitate the germination of yeast. These changes may transform asymptomatic colonization into symptomatic infection. In patients with trichomoniasis, changes in estrogen and progesterone levels, as well as elevations of vaginal pH and glycogen levels, may enhance the growth and virulence of Trichomonas vaginalis.

• #31 Diagnosis of Vaginitis | AAFP

  https://www.aafp.org/pubs/afp/issues/2000/0901/p1095.html

  Similarly, changes in the vaginal environment, such as an increase in glycogen production in pregnancy or altered estrogen and progesterone levels from the use of oral contraceptives, enhance the adherence of Candida albicans to vaginal epithelial cells and facilitate the germination of yeast. These changes may transform asymptomatic colonization into symptomatic infection. In patients with trichomoniasis, changes in estrogen and progesterone levels, as well as elevations of vaginal pH and glycogen levels, may enhance the growth and virulence of Trichomonas vaginalis.

• #32 Vaginitis – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/vaginitis/symptoms-causes/syc-20354707

  Reduced estrogen levels after menopause or surgical removal of your ovaries can cause the vaginal lining to thin, sometimes resulting in vaginal irritation, burning and dryness. […] Women with trichomoniasis or bacterial vaginosis are at a greater risk of getting sexually transmitted infections because of the inflammation caused by these disorders.

• #33 Vaginitis – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/vaginitis/symptoms-causes/syc-20354707

  Reduced estrogen levels after menopause or surgical removal of your ovaries can cause the vaginal lining to thin, sometimes resulting in vaginal irritation, burning and dryness. […] Women with trichomoniasis or bacterial vaginosis are at a greater risk of getting sexually transmitted infections because of the inflammation caused by these disorders.

• #34 Vaginitis > Fact Sheets > Yale Medicine

  https://www.yalemedicine.org/conditions/vaginitis

  Bacterial vaginosis is responsible for up to half of all vaginitis cases in the U.S. It is trigged by an overgrowth of bad bacteria in the vagina. […] At different stages in life, such as during pregnancy or while breastfeeding, a woman will have fluctuations in her levels of the hormone estrogen. A decrease in estrogen naturally happens during menopause, and continues afterwards, when estrogen levels stay permanently low. […] Pathologists can diagnose the causes of vaginitis, both non-infectious and infectious, by visually examining a Pap Test slide under the microscope. […] In pregnant women, symptomatic infectious vaginitis/vaginosis has been associated with premature deliveries and low birth weight babies.

• #35

  https://www.cgh.com.sg/patient-care/conditions-treatments/vaginitis

  Atrophic vaginitis refers to a type of vaginitis that occurs because of oestrogen deficiency, usually after menopause. It occurs in up to 40 percent of postmenopausal women. […] Oestrogen stimulates the growth of lactobacilli in the vagina. Lack of oestrogen causes thinning of the vaginal skin and increases the pH of the vaginal environment. This predisposes the genital area to infection.

• #36

  https://www.cgh.com.sg/patient-care/conditions-treatments/vaginitis

  Atrophic vaginitis refers to a type of vaginitis that occurs because of oestrogen deficiency, usually after menopause. It occurs in up to 40 percent of postmenopausal women. […] Oestrogen stimulates the growth of lactobacilli in the vagina. Lack of oestrogen causes thinning of the vaginal skin and increases the pH of the vaginal environment. This predisposes the genital area to infection.

• #37 Vaginitis: Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/0401/p807.html

  Bacterial vaginosis, trichomoniasis, and vulvovaginal candidiasis are the most common infectious causes of vaginitis. Bacterial vaginosis occurs when the normal lactobacilli of the vagina are replaced by mostly anaerobic bacteria. […] Atrophic vaginitis, a form of vaginitis caused by estrogen deficiency, produces symptoms of vaginal dryness, itching, irritation, discharge, and dyspareunia. […] The most common infectious causes of vaginitis are bacterial vaginosis, vulvovaginal candidiasis, and trichomoniasis. […] The underlying cause of bacterial vaginosis is not fully understood. […] Bacterial vaginosis is associated with late miscarriages, premature rupture of membranes, and preterm birth. […] Bacterial vaginosis, even when asymptomatic, is associated with a high incidence of endometritis and pelvic inflammatory disease following abortion and gynecologic procedures in the general population.

• #38 Vaginitis: Causes, Symptoms, Treatment & Prevention

  https://my.clevelandclinic.org/health/diseases/9131-vaginitis

  Vaginitis is a general term to describe conditions that cause inflammation or irritation to your vagina. Depending on the cause, you could have symptoms like itchiness, a burning feeling when you pee or foul-smelling vaginal discharge. […] You can get vaginitis from bacteria, fungi, parasites or other organisms, or chemicals in creams or personal hygiene products. In some cases, vaginitis occurs due to sexually transmitted infections (STIs) or vaginal dryness from low estrogen levels. […] There are many possible causes of vaginitis, and each cause has its own symptoms and treatment. […] Two of the most common types of vaginitis yeast infections and bacterial vaginosis occur when bacteria naturally occurring in your vagina become unbalanced in some way. Taking antibiotics can also disrupt the normal bacteria in your vagina, leading to a yeast infection.

• #39 Vaginitis (Vaginal Infections): Symptoms, Types, Causes, Treatment

  https://www.webmd.com/women/sexual-health-vaginal-infections

  Vaginitis can be caused by microbial imbalances, STIs, chemicals, or hormonal imbalances. […] A healthy vagina has certain bacteria and other microbes. Usually, there are many different kinds of microbes, and they all live in balance. You might hear this called your vaginal microbiome or flora. […] When this happens, one microbe can grow too much, or an unwelcome microbe can take hold and cause an infection. This can lead to vaginitis. […] Microbial imbalances can be caused by: Antibiotics. Antimicrobial drugs, including antibiotics, are medicines that kill germs. Antibiotics kill unfriendly germs, but they also can kill friendly germs. […] When you take antibiotics for a urinary tract infection or other illnesses, they can kill the friendly germs in your vagina. This leaves extra room for other microbes to grow.

• #40 Vaginitis – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/vaginitis/symptoms-causes/syc-20354707

  Vaginitis is an inflammation of the vagina that can result in discharge, itching and pain. The cause is usually a change in the balance of vaginal bacteria or an infection. Reduced estrogen levels after menopause and some skin disorders also can cause vaginitis. […] This most common type of vaginitis results from a change of the bacteria found in your vagina, upsetting the balance. What causes the imbalance is unknown. It’s possible to have bacterial vaginosis without symptoms. […] This common sexually transmitted infection is caused by a microscopic, one-celled parasite called Trichomonas vaginalis. This organism spreads during sex with someone who has the infection. […] Vaginal sprays, douches, perfumed soaps, scented detergents and spermicidal products can cause an allergic reaction or irritate vulvar and vaginal tissues. Foreign objects, such as toilet paper or forgotten tampons, in the vagina also can irritate vaginal tissues.

• #41 Vaginitis – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/vaginitis/symptoms-causes/syc-20354707

  Vaginitis is an inflammation of the vagina that can result in discharge, itching and pain. The cause is usually a change in the balance of vaginal bacteria or an infection. Reduced estrogen levels after menopause and some skin disorders also can cause vaginitis. […] This most common type of vaginitis results from a change of the bacteria found in your vagina, upsetting the balance. What causes the imbalance is unknown. It’s possible to have bacterial vaginosis without symptoms. […] This common sexually transmitted infection is caused by a microscopic, one-celled parasite called Trichomonas vaginalis. This organism spreads during sex with someone who has the infection. […] Vaginal sprays, douches, perfumed soaps, scented detergents and spermicidal products can cause an allergic reaction or irritate vulvar and vaginal tissues. Foreign objects, such as toilet paper or forgotten tampons, in the vagina also can irritate vaginal tissues.

• #42 Vaginitis: Etiology and Role of Oxidative Stress, Inflammation and Antioxidants Therapy

  https://clinmedjournals.org/articles/rmi/reproductive-medicine-international-rmi-4-014.php?jid=rmi

  Vaginitis is an inflammation process which can be caused by multiple factors and conditions. […] Identification of underlying mechanisms and signaling pathways related to vaginitis gives us valuable information regarding the way for developing a better clinical approach and disease treatment. […] Oxidative stress (OS) and antioxidants depletion is likely a main reason for vaginitis development and pathology. […] Therefore, OS plays an important role in the development and pathogenesis of vaginitis. […] Recent studies have shown that reactive oxygen species (ROS) and oxidative stress (OS) caused by antioxidant depletion are a main underlying mechanism for vaginitis. […] Data suggest that antioxidant therapy may induce antioxidant response to the oxidative stress and cause vaginitis improvement, while antioxidants depletion can be associated with ROS overproduction, oxidative stress and consequently vaginitis.

• #43 Vaginitis: Etiology and Role of Oxidative Stress, Inflammation and Antioxidants Therapy

  https://clinmedjournals.org/articles/rmi/reproductive-medicine-international-rmi-4-014.php?jid=rmi

  Vaginitis is an inflammation process which can be caused by multiple factors and conditions. […] Identification of underlying mechanisms and signaling pathways related to vaginitis gives us valuable information regarding the way for developing a better clinical approach and disease treatment. […] Oxidative stress (OS) and antioxidants depletion is likely a main reason for vaginitis development and pathology. […] Therefore, OS plays an important role in the development and pathogenesis of vaginitis. […] Recent studies have shown that reactive oxygen species (ROS) and oxidative stress (OS) caused by antioxidant depletion are a main underlying mechanism for vaginitis. […] Data suggest that antioxidant therapy may induce antioxidant response to the oxidative stress and cause vaginitis improvement, while antioxidants depletion can be associated with ROS overproduction, oxidative stress and consequently vaginitis.

• #44 Vaginitis: Etiology and Role of Oxidative Stress, Inflammation and Antioxidants Therapy

  https://clinmedjournals.org/articles/rmi/reproductive-medicine-international-rmi-4-014.php?jid=rmi

  Vaginitis is an inflammation process which can be caused by multiple factors and conditions. […] Identification of underlying mechanisms and signaling pathways related to vaginitis gives us valuable information regarding the way for developing a better clinical approach and disease treatment. […] Oxidative stress (OS) and antioxidants depletion is likely a main reason for vaginitis development and pathology. […] Therefore, OS plays an important role in the development and pathogenesis of vaginitis. […] Recent studies have shown that reactive oxygen species (ROS) and oxidative stress (OS) caused by antioxidant depletion are a main underlying mechanism for vaginitis. […] Data suggest that antioxidant therapy may induce antioxidant response to the oxidative stress and cause vaginitis improvement, while antioxidants depletion can be associated with ROS overproduction, oxidative stress and consequently vaginitis.

• #45 Vaginitis: Etiology and Role of Oxidative Stress, Inflammation and Antioxidants Therapy

  https://clinmedjournals.org/articles/rmi/reproductive-medicine-international-rmi-4-014.php?jid=rmi

  Recent studies have indicated that oxidative stress and inflammation may be a main reason for vaginitis development. […] Therefore, oxidative stress played an important role in vaginitis and antioxidant therapy seems to be helpful for the treatment of vaginitis. […] Although multiple factors are involved in the etiology of vaginitis, oxidative stress and apoptosis is one of main reason for the development and pathogenesis of vaginitis. […] An increasing number of evidence suggests that OS induced by ROS is likely a main mechanism of vaginitis development and pathogenesis which is associated with antioxidants depletion, DNA fragmentation, lipid and protein oxidation, inflammation, accumulation of leukocytes at the site of damaged tissues, as well as cells apoptosis and tissue damage.

• #46 Bacterial Vaginosis and Vulvovaginal Candidiasis Pathophysiologic Interrelationship

  https://www.mdpi.com/2076-2607/12/1/108

  Among the infectious causes of vulvovaginal symptoms, bacterial vaginosis (BV) and vulvovaginal candidiasis (VVC) dominate. […] The biologic basis for this critical interrelationship is discussed and suggests that as a consequence of BV dysbiosis, and not necessarily because of antibiotics prescribed, immune defenses are compromised, neutralizing vaginal yeast tolerance. […] The primary pathogens in VVC are Candida species, likely originating from the gastrointestinal tract and achieving initial asymptomatic vaginal colonization as commensals. […] The local effect of estrogen plays a dominant role in the healthy lower genital tract microbiome in allowing Candida commensalism. […] The outcome of benign asymptomatic colonization as well as Candida vaginitis reflects the interplay of three factors: yeast, vaginal microbiota, and host mucosal immune factors.

• #47 Bacterial Vaginosis and Vulvovaginal Candidiasis Pathophysiologic Interrelationship

  https://www.mdpi.com/2076-2607/12/1/108

  Among the infectious causes of vulvovaginal symptoms, bacterial vaginosis (BV) and vulvovaginal candidiasis (VVC) dominate. […] The biologic basis for this critical interrelationship is discussed and suggests that as a consequence of BV dysbiosis, and not necessarily because of antibiotics prescribed, immune defenses are compromised, neutralizing vaginal yeast tolerance. […] The primary pathogens in VVC are Candida species, likely originating from the gastrointestinal tract and achieving initial asymptomatic vaginal colonization as commensals. […] The local effect of estrogen plays a dominant role in the healthy lower genital tract microbiome in allowing Candida commensalism. […] The outcome of benign asymptomatic colonization as well as Candida vaginitis reflects the interplay of three factors: yeast, vaginal microbiota, and host mucosal immune factors.

• #48 Bacterial Vaginosis and Vulvovaginal Candidiasis Pathophysiologic Interrelationship

  https://www.mdpi.com/2076-2607/12/1/108

  Acute symptomatic Candida vulvovaginitis represents a dramatic change triggered by multiple factors but always requiring prior vaginal yeast colonization and characterized by proliferation of yeast blastospores and hyphae formation with expression of multiple fungal virulence factors, and these microbiome changes result in superficial vaginal epithelial surface invasion and consequent vaginal epithelial cell proinflammatory reaction. […] Unlike VVC, with a single or mono-pathogen pathogenesis, BV represents a severe polymicrobial vaginal dysbiosis with loss or disappearance of what is considered “healthy” protective Lactobacillus species and overgrowth of multiple largely strict anaerobic and facultative species, creating a more diverse bacterial abundance. […] More recently, the recognition and appreciation of the BV biofilm coating the surface of the vaginal mucosa has contributed to understanding the pathogenesis of BV, especially RBV, and has improved treatment of BV.

• #49 Bacterial Vaginosis and Vulvovaginal Candidiasis Pathophysiologic Interrelationship

  https://www.mdpi.com/2076-2607/12/1/108

  Acute symptomatic Candida vulvovaginitis represents a dramatic change triggered by multiple factors but always requiring prior vaginal yeast colonization and characterized by proliferation of yeast blastospores and hyphae formation with expression of multiple fungal virulence factors, and these microbiome changes result in superficial vaginal epithelial surface invasion and consequent vaginal epithelial cell proinflammatory reaction. […] Unlike VVC, with a single or mono-pathogen pathogenesis, BV represents a severe polymicrobial vaginal dysbiosis with loss or disappearance of what is considered “healthy” protective Lactobacillus species and overgrowth of multiple largely strict anaerobic and facultative species, creating a more diverse bacterial abundance. […] More recently, the recognition and appreciation of the BV biofilm coating the surface of the vaginal mucosa has contributed to understanding the pathogenesis of BV, especially RBV, and has improved treatment of BV.

• #50 Vaginitis, TSS, and other Genitourinary Tract Infections

  https://www.atsu.edu/faculty/chamberlain/website/lectures/lecture/stdd.htm

  Women who have been diagnosed with BV have up to 1,000 times more anaerobic bacteria than women without the disease. […] Instead of the normal predominance of Lactobacillus bacteria, increased numbers of organisms such as Gardnerella vaginalis, Atopobium vaginae, various anaerobes and Mycoplasma hominis are found in the vagina in women with BV. […] The cause of this imbalance in the microflora of the vaginal mucosa is not currently known. […] Overgrowth of Gardnerella vaginalis and other resident anaerobes only partially explains how BV develops. […] The biofilm formed by Gardnerella vaginalis et al., in BV is dense and strongly adherent to the vaginal epithelium. […] The presence of the biofilm enables the bacterial cells to reach higher concentrations (up to 1011 bacteria/mL) than in vaginal fluid and boosts their resistance to both the host immune system and the antimicrobials. […] It has also been shown that Atopobium vaginae is quite resistant to drugs commonly used to treat BV (metronidazole).

• #51 Vaginitis, TSS, and other Genitourinary Tract Infections

  https://www.atsu.edu/faculty/chamberlain/website/lectures/lecture/stdd.htm

  Women who have been diagnosed with BV have up to 1,000 times more anaerobic bacteria than women without the disease. […] Instead of the normal predominance of Lactobacillus bacteria, increased numbers of organisms such as Gardnerella vaginalis, Atopobium vaginae, various anaerobes and Mycoplasma hominis are found in the vagina in women with BV. […] The cause of this imbalance in the microflora of the vaginal mucosa is not currently known. […] Overgrowth of Gardnerella vaginalis and other resident anaerobes only partially explains how BV develops. […] The biofilm formed by Gardnerella vaginalis et al., in BV is dense and strongly adherent to the vaginal epithelium. […] The presence of the biofilm enables the bacterial cells to reach higher concentrations (up to 1011 bacteria/mL) than in vaginal fluid and boosts their resistance to both the host immune system and the antimicrobials. […] It has also been shown that Atopobium vaginae is quite resistant to drugs commonly used to treat BV (metronidazole).

• #52 Vaginitis, TSS, and other Genitourinary Tract Infections

  https://www.atsu.edu/faculty/chamberlain/website/lectures/lecture/stdd.htm

  Women who have been diagnosed with BV have up to 1,000 times more anaerobic bacteria than women without the disease. […] Instead of the normal predominance of Lactobacillus bacteria, increased numbers of organisms such as Gardnerella vaginalis, Atopobium vaginae, various anaerobes and Mycoplasma hominis are found in the vagina in women with BV. […] The cause of this imbalance in the microflora of the vaginal mucosa is not currently known. […] Overgrowth of Gardnerella vaginalis and other resident anaerobes only partially explains how BV develops. […] The biofilm formed by Gardnerella vaginalis et al., in BV is dense and strongly adherent to the vaginal epithelium. […] The presence of the biofilm enables the bacterial cells to reach higher concentrations (up to 1011 bacteria/mL) than in vaginal fluid and boosts their resistance to both the host immune system and the antimicrobials. […] It has also been shown that Atopobium vaginae is quite resistant to drugs commonly used to treat BV (metronidazole).

• #53 Bacterial Vaginosis and Vulvovaginal Candidiasis Pathophysiologic Interrelationship

  https://www.mdpi.com/2076-2607/12/1/108

  Acute symptomatic Candida vulvovaginitis represents a dramatic change triggered by multiple factors but always requiring prior vaginal yeast colonization and characterized by proliferation of yeast blastospores and hyphae formation with expression of multiple fungal virulence factors, and these microbiome changes result in superficial vaginal epithelial surface invasion and consequent vaginal epithelial cell proinflammatory reaction. […] Unlike VVC, with a single or mono-pathogen pathogenesis, BV represents a severe polymicrobial vaginal dysbiosis with loss or disappearance of what is considered “healthy” protective Lactobacillus species and overgrowth of multiple largely strict anaerobic and facultative species, creating a more diverse bacterial abundance. […] More recently, the recognition and appreciation of the BV biofilm coating the surface of the vaginal mucosa has contributed to understanding the pathogenesis of BV, especially RBV, and has improved treatment of BV.

• #54 Bacterial Vaginosis (BV) – Gynecology and Obstetrics – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/gynecology-and-obstetrics/vaginitis-cervicitis-and-pelvic-inflammatory-disease/bacterial-vaginosis-bv

  Bacterial vaginosis is the most common infectious vaginitis. The pathogenesis is unclear but involves the overgrowth of multiple bacterial pathogens and a decrease in the usual lactobacillus-predominant vaginal flora. […] Anaerobic pathogens that overgrow include Prevotella species, Peptostreptococcus species, Gardnerella vaginalis, Mobiluncus species, and Mycoplasma hominis, which increase in concentration by 10- to 100-fold and replace the lactobacilli that usually maintain a normal vaginal environment. […] Bacterial vaginosis appears to increase the risk of pelvic inflammatory disease, postabortion and postpartum endometritis, and posthysterectomy vaginal cuff infection. In pregnancy, bacterial vaginosis is associated with an increased risk of chorioamnionitis, prelabor rupture of membranes, preterm labor, and preterm birth.

• #55 Bacterial Vaginosis (BV) – Gynecology and Obstetrics – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/gynecology-and-obstetrics/vaginitis-cervicitis-and-pelvic-inflammatory-disease/bacterial-vaginosis-bv

  Bacterial vaginosis is the most common infectious vaginitis. The pathogenesis is unclear but involves the overgrowth of multiple bacterial pathogens and a decrease in the usual lactobacillus-predominant vaginal flora. […] Anaerobic pathogens that overgrow include Prevotella species, Peptostreptococcus species, Gardnerella vaginalis, Mobiluncus species, and Mycoplasma hominis, which increase in concentration by 10- to 100-fold and replace the lactobacilli that usually maintain a normal vaginal environment. […] Bacterial vaginosis appears to increase the risk of pelvic inflammatory disease, postabortion and postpartum endometritis, and posthysterectomy vaginal cuff infection. In pregnancy, bacterial vaginosis is associated with an increased risk of chorioamnionitis, prelabor rupture of membranes, preterm labor, and preterm birth.

• #56 Vaginitis Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/condition/vaginitis

  HIV acquisition is increased among women with vaginitis. So prompt and effective treatment is critical. […] Yeast infections occur twice as often during pregnancy due to hormone fluctuations. The vagina may also be affected by skin conditions, or dermatoses. Diagnosis and treatment of these conditions is difficult because of the poor visibility in the vagina, and a lack of appropriate medications that are safe for use in the vagina.

• #57 Vaginitis: Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/0401/p807.html

  Bacterial vaginosis, trichomoniasis, and vulvovaginal candidiasis are the most common infectious causes of vaginitis. Bacterial vaginosis occurs when the normal lactobacilli of the vagina are replaced by mostly anaerobic bacteria. […] Atrophic vaginitis, a form of vaginitis caused by estrogen deficiency, produces symptoms of vaginal dryness, itching, irritation, discharge, and dyspareunia. […] The most common infectious causes of vaginitis are bacterial vaginosis, vulvovaginal candidiasis, and trichomoniasis. […] The underlying cause of bacterial vaginosis is not fully understood. […] Bacterial vaginosis is associated with late miscarriages, premature rupture of membranes, and preterm birth. […] Bacterial vaginosis, even when asymptomatic, is associated with a high incidence of endometritis and pelvic inflammatory disease following abortion and gynecologic procedures in the general population.

• #58 Vaginitis | Cedars-Sinai

  https://www.cedars-sinai.org/health-library/diseases-and-conditions/v/vaginitis.html

  Without treatment, vaginitis caused by bacterial vaginosis (BV) or trichomoniasis (trich) can increase the risk of more serious health problems, such as: Pelvic inflammatory disease (PID), Giving birth to a baby early if you’re pregnant (preterm delivery), HIV and certain other sexually transmitted infections (STIs).

• #59 Vaginitis | Cedars-Sinai

  https://www.cedars-sinai.org/health-library/diseases-and-conditions/v/vaginitis.html

  Without treatment, vaginitis caused by bacterial vaginosis (BV) or trichomoniasis (trich) can increase the risk of more serious health problems, such as: Pelvic inflammatory disease (PID), Giving birth to a baby early if you’re pregnant (preterm delivery), HIV and certain other sexually transmitted infections (STIs).

• #60 Vaginitis | Cedars-Sinai

  https://www.cedars-sinai.org/health-library/diseases-and-conditions/v/vaginitis.html

  Without treatment, vaginitis caused by bacterial vaginosis (BV) or trichomoniasis (trich) can increase the risk of more serious health problems, such as: Pelvic inflammatory disease (PID), Giving birth to a baby early if you’re pregnant (preterm delivery), HIV and certain other sexually transmitted infections (STIs).

• #61 Bacterial vaginosis and pregnancy | March of Dimes

  https://www.marchofdimes.org/find-support/topics/pregnancy/bacterial-vaginosis-and-pregnancy

  Bacterial vaginosis (also called BV or vaginitis) is an infection caused when there’s too much of certain bacteria in the vagina. It’s the most common vaginal infection in women ages 15 to 44. […] We don’t know for sure what causes BV. Any woman can get it, but you’re at increased risk for BV if you: […] Pregnant women are at increased risk for BV because of hormone changes that happen during pregnancy. Hormones are chemicals made by the body. […] If you have BV during pregnancy, your baby is at increased risk for preterm birth and low birthweight. Preterm birth is birth before 37 weeks of pregnancy. Low birthweight is when your baby is born weighing less than 5 pounds, 8 ounces. Being born too early or too small can cause health problems for your baby. […] BV also can cause pelvic inflammatory diseases (also called PID). PID is an infection in the uterus that can increase your risk for infertility (not being able to get pregnant).

• #62 Bacterial vaginosis and pregnancy | March of Dimes

  https://www.marchofdimes.org/find-support/topics/pregnancy/bacterial-vaginosis-and-pregnancy

  Bacterial vaginosis (also called BV or vaginitis) is an infection caused when there’s too much of certain bacteria in the vagina. It’s the most common vaginal infection in women ages 15 to 44. […] We don’t know for sure what causes BV. Any woman can get it, but you’re at increased risk for BV if you: […] Pregnant women are at increased risk for BV because of hormone changes that happen during pregnancy. Hormones are chemicals made by the body. […] If you have BV during pregnancy, your baby is at increased risk for preterm birth and low birthweight. Preterm birth is birth before 37 weeks of pregnancy. Low birthweight is when your baby is born weighing less than 5 pounds, 8 ounces. Being born too early or too small can cause health problems for your baby. […] BV also can cause pelvic inflammatory diseases (also called PID). PID is an infection in the uterus that can increase your risk for infertility (not being able to get pregnant).

• #63 Bacterial vaginosis and pregnancy | March of Dimes

  https://www.marchofdimes.org/find-support/topics/pregnancy/bacterial-vaginosis-and-pregnancy

  Bacterial vaginosis (also called BV or vaginitis) is an infection caused when there’s too much of certain bacteria in the vagina. It’s the most common vaginal infection in women ages 15 to 44. […] We don’t know for sure what causes BV. Any woman can get it, but you’re at increased risk for BV if you: […] Pregnant women are at increased risk for BV because of hormone changes that happen during pregnancy. Hormones are chemicals made by the body. […] If you have BV during pregnancy, your baby is at increased risk for preterm birth and low birthweight. Preterm birth is birth before 37 weeks of pregnancy. Low birthweight is when your baby is born weighing less than 5 pounds, 8 ounces. Being born too early or too small can cause health problems for your baby. […] BV also can cause pelvic inflammatory diseases (also called PID). PID is an infection in the uterus that can increase your risk for infertility (not being able to get pregnant).

• #64 Vaginitis > Fact Sheets > Yale Medicine

  https://www.yalemedicine.org/conditions/vaginitis

  Bacterial vaginosis is responsible for up to half of all vaginitis cases in the U.S. It is trigged by an overgrowth of bad bacteria in the vagina. […] At different stages in life, such as during pregnancy or while breastfeeding, a woman will have fluctuations in her levels of the hormone estrogen. A decrease in estrogen naturally happens during menopause, and continues afterwards, when estrogen levels stay permanently low. […] Pathologists can diagnose the causes of vaginitis, both non-infectious and infectious, by visually examining a Pap Test slide under the microscope. […] In pregnant women, symptomatic infectious vaginitis/vaginosis has been associated with premature deliveries and low birth weight babies.

• #65 Vaginitis – teachIM

  https://teachim.org/teaching_material/vaginitis/

  Diagnostic testing for vaginitis should include point of care pH testing and microscopy with a potassium hydroxide (KOH) and wet prep when possible. […] A fishy smell noted during this preparation would be a positive whiff test. […] A pH of 4.5 is highly sensitive for BV, and a positive whiff test is specific for this diagnosis. […] Vaginal pH is normal in the setting of yeast vulvovaginitis with a negative Whiff test. […] pH is generally elevated with Trich, although this is less sensitive and specific than an elevated pH for BV. […] Treatment for BV can be topical or oral metronidazole or clindamycin. […] Yeast can be treated with topical miconazole or clotrimazole or with oral fluconazole. […] Treatment for trichomonas is with oral metronidazole or tinidazole, with metronidazole preferred in pregnancy.

• #66 Vaginitis – teachIM

  https://teachim.org/teaching_material/vaginitis/

  Diagnostic testing for vaginitis should include point of care pH testing and microscopy with a potassium hydroxide (KOH) and wet prep when possible. […] A fishy smell noted during this preparation would be a positive whiff test. […] A pH of 4.5 is highly sensitive for BV, and a positive whiff test is specific for this diagnosis. […] Vaginal pH is normal in the setting of yeast vulvovaginitis with a negative Whiff test. […] pH is generally elevated with Trich, although this is less sensitive and specific than an elevated pH for BV. […] Treatment for BV can be topical or oral metronidazole or clindamycin. […] Yeast can be treated with topical miconazole or clotrimazole or with oral fluconazole. […] Treatment for trichomonas is with oral metronidazole or tinidazole, with metronidazole preferred in pregnancy.

• #67 Vaginitis – teachIM

  https://teachim.org/teaching_material/vaginitis/

  Diagnostic testing for vaginitis should include point of care pH testing and microscopy with a potassium hydroxide (KOH) and wet prep when possible. […] A fishy smell noted during this preparation would be a positive whiff test. […] A pH of 4.5 is highly sensitive for BV, and a positive whiff test is specific for this diagnosis. […] Vaginal pH is normal in the setting of yeast vulvovaginitis with a negative Whiff test. […] pH is generally elevated with Trich, although this is less sensitive and specific than an elevated pH for BV. […] Treatment for BV can be topical or oral metronidazole or clindamycin. […] Yeast can be treated with topical miconazole or clotrimazole or with oral fluconazole. […] Treatment for trichomonas is with oral metronidazole or tinidazole, with metronidazole preferred in pregnancy.

• #68 Vaginitis – teachIM

  https://teachim.org/teaching_material/vaginitis/

  Diagnostic testing for vaginitis should include point of care pH testing and microscopy with a potassium hydroxide (KOH) and wet prep when possible. […] A fishy smell noted during this preparation would be a positive whiff test. […] A pH of 4.5 is highly sensitive for BV, and a positive whiff test is specific for this diagnosis. […] Vaginal pH is normal in the setting of yeast vulvovaginitis with a negative Whiff test. […] pH is generally elevated with Trich, although this is less sensitive and specific than an elevated pH for BV. […] Treatment for BV can be topical or oral metronidazole or clindamycin. […] Yeast can be treated with topical miconazole or clotrimazole or with oral fluconazole. […] Treatment for trichomonas is with oral metronidazole or tinidazole, with metronidazole preferred in pregnancy.

• #69 Vaginitis – teachIM

  https://teachim.org/teaching_material/vaginitis/

  Diagnostic testing for vaginitis should include point of care pH testing and microscopy with a potassium hydroxide (KOH) and wet prep when possible. […] A fishy smell noted during this preparation would be a positive whiff test. […] A pH of 4.5 is highly sensitive for BV, and a positive whiff test is specific for this diagnosis. […] Vaginal pH is normal in the setting of yeast vulvovaginitis with a negative Whiff test. […] pH is generally elevated with Trich, although this is less sensitive and specific than an elevated pH for BV. […] Treatment for BV can be topical or oral metronidazole or clindamycin. […] Yeast can be treated with topical miconazole or clotrimazole or with oral fluconazole. […] Treatment for trichomonas is with oral metronidazole or tinidazole, with metronidazole preferred in pregnancy.

• #70 Vaginitis in adults and adolescents: Initial evaluation – UpToDate

  https://www.uptodate.com/contents/approach-to-females-with-symptoms-of-vaginitis

  The clinical evaluation consists of a history, physical examination, and testing of vaginal discharge for evidence of infection. […] […] The vaginal discharge is tested for bacterial vaginosis (BV), vulvovaginal candidiasis, and trichomoniasis using either pH testing with microscopy and/or laboratory tests (typically nucleic acid amplification tests). Sexually active individuals are also tested for sexually transmitted cervical infections (eg, gonorrhea, chlamydia) as coinfection may be present. […] […] Twenty-five to 40 percent of patients with genital symptoms do not have a specific cause identified on initial diagnostic evaluation. […] […] Given the nonspecific nature of vaginitis symptoms, identifying the etiology is mandatory before initiating therapy. Diagnostic testing enables targeted treatment, increases therapeutic compliance, and increases the likelihood of partner notification. […]

• #71 Vaginitis – teachIM

  https://teachim.org/teaching_material/vaginitis/

  Diagnostic testing for vaginitis should include point of care pH testing and microscopy with a potassium hydroxide (KOH) and wet prep when possible. […] A fishy smell noted during this preparation would be a positive whiff test. […] A pH of 4.5 is highly sensitive for BV, and a positive whiff test is specific for this diagnosis. […] Vaginal pH is normal in the setting of yeast vulvovaginitis with a negative Whiff test. […] pH is generally elevated with Trich, although this is less sensitive and specific than an elevated pH for BV. […] Treatment for BV can be topical or oral metronidazole or clindamycin. […] Yeast can be treated with topical miconazole or clotrimazole or with oral fluconazole. […] Treatment for trichomonas is with oral metronidazole or tinidazole, with metronidazole preferred in pregnancy.

• #72 Vaginitis – teachIM

  https://teachim.org/teaching_material/vaginitis/

  Diagnostic testing for vaginitis should include point of care pH testing and microscopy with a potassium hydroxide (KOH) and wet prep when possible. […] A fishy smell noted during this preparation would be a positive whiff test. […] A pH of 4.5 is highly sensitive for BV, and a positive whiff test is specific for this diagnosis. […] Vaginal pH is normal in the setting of yeast vulvovaginitis with a negative Whiff test. […] pH is generally elevated with Trich, although this is less sensitive and specific than an elevated pH for BV. […] Treatment for BV can be topical or oral metronidazole or clindamycin. […] Yeast can be treated with topical miconazole or clotrimazole or with oral fluconazole. […] Treatment for trichomonas is with oral metronidazole or tinidazole, with metronidazole preferred in pregnancy.

• #73 Vaginitis – teachIM

  https://teachim.org/teaching_material/vaginitis/

  Diagnostic testing for vaginitis should include point of care pH testing and microscopy with a potassium hydroxide (KOH) and wet prep when possible. […] A fishy smell noted during this preparation would be a positive whiff test. […] A pH of 4.5 is highly sensitive for BV, and a positive whiff test is specific for this diagnosis. […] Vaginal pH is normal in the setting of yeast vulvovaginitis with a negative Whiff test. […] pH is generally elevated with Trich, although this is less sensitive and specific than an elevated pH for BV. […] Treatment for BV can be topical or oral metronidazole or clindamycin. […] Yeast can be treated with topical miconazole or clotrimazole or with oral fluconazole. […] Treatment for trichomonas is with oral metronidazole or tinidazole, with metronidazole preferred in pregnancy.

• #74

  https://myhealth.alberta.ca/Health/pages/conditions.aspx?hwid=zx1776

  Treatment depends on the type of infection you have. Types include: Yeast infection. Yeast infections can be treated with an over-the-counter antifungal medicine that you put into your vagina. […] Bacterial vaginosis. This is usually a mild problem. But it can lead to more serious problems, so it’s a good idea to see your doctor. It’s usually treated with antibiotics. […] Trichomoniasis. This is treated with antibiotics. Both you and your sex partner or partners need treatment. […] Atrophic vaginitis. This usually is treated with estrogen creams or tablets.

• #75 Bacterial vaginosis and pregnancy | March of Dimes

  https://www.marchofdimes.org/find-support/topics/pregnancy/bacterial-vaginosis-and-pregnancy

  BV is treated with antibiotics. Antibiotics are medicines that kill infections caused by bacteria. The antibiotic may be oral (taken by mouth) or a cream or gel that you put into your vagina. Treatment with antibiotics for BV is safe for your baby during pregnancy, and it may help reduce your risk for STDs.

• #76 Vaginitis: Etiology and Role of Oxidative Stress, Inflammation and Antioxidants Therapy

  https://clinmedjournals.org/articles/rmi/reproductive-medicine-international-rmi-4-014.php?jid=rmi

  Recent studies have indicated that oxidative stress and inflammation may be a main reason for vaginitis development. […] Therefore, oxidative stress played an important role in vaginitis and antioxidant therapy seems to be helpful for the treatment of vaginitis. […] Although multiple factors are involved in the etiology of vaginitis, oxidative stress and apoptosis is one of main reason for the development and pathogenesis of vaginitis. […] An increasing number of evidence suggests that OS induced by ROS is likely a main mechanism of vaginitis development and pathogenesis which is associated with antioxidants depletion, DNA fragmentation, lipid and protein oxidation, inflammation, accumulation of leukocytes at the site of damaged tissues, as well as cells apoptosis and tissue damage.

• #77 UTHSC’s Brian Peters, PhD, Receives $1.5 Million Grant for Research on Vaginitis Pathogenesis – UTHSC News

  https://news.uthsc.edu/uthscs-brian-peters-phd-receives-1-52-million-grant-for-research-on-vaginitis-pathogenesis/

  Brian M. Peters, PhD, assistant professor in the Department of Clinical Pharmacy and Translational Science in the College of Pharmacy at the University of Tennessee Health Science Center (UTHSC), has been awarded a four-year $1,520,000 grant for his research into the molecular pathways through which Candida albicans, or C. albicans, elicits inflammation during vaginitis. […] Long believed to result from immunodeficiency, a growing body of evidence strongly suggests that vaginitis is now considered to be an immunopathology, in which the host response actually drives disease symptoms. […] Under this project entitled, Candidalysin: a key mediator of Candida vaginitis immunopathology, Dr. Peters and his lab have been working to understand how a newly described fungal toxin Candidalysin majorly contributes to the pathogenesis of vulvovaginal candidiasis, also known as a genital yeast infections.

• #78 UTHSC’s Brian Peters, PhD, Receives $1.5 Million Grant for Research on Vaginitis Pathogenesis – UTHSC News

  https://news.uthsc.edu/uthscs-brian-peters-phd-receives-1-52-million-grant-for-research-on-vaginitis-pathogenesis/

  Brian M. Peters, PhD, assistant professor in the Department of Clinical Pharmacy and Translational Science in the College of Pharmacy at the University of Tennessee Health Science Center (UTHSC), has been awarded a four-year $1,520,000 grant for his research into the molecular pathways through which Candida albicans, or C. albicans, elicits inflammation during vaginitis. […] Long believed to result from immunodeficiency, a growing body of evidence strongly suggests that vaginitis is now considered to be an immunopathology, in which the host response actually drives disease symptoms. […] Under this project entitled, Candidalysin: a key mediator of Candida vaginitis immunopathology, Dr. Peters and his lab have been working to understand how a newly described fungal toxin Candidalysin majorly contributes to the pathogenesis of vulvovaginal candidiasis, also known as a genital yeast infections.

• #79 Candidal Vaginitis – Gynecology and Obstetrics – MSD Manual Professional Edition

  https://www.msdmanuals.com/professional/gynecology-and-obstetrics/vaginitis-cervicitis-and-pelvic-inflammatory-disease/candidal-vaginitis

  Most fungal vaginitis is caused by C. albicans (candidiasis), which colonizes 15 to 20% of nonpregnant and 20 to 40% of pregnant women. […] Recurrences after treatment may occur if there is resistance to antifungals or if a patient has non- Candida albicans species like Candida glabrata. […] Criteria for diagnosing candidal vaginitis include typical discharge (a thick, white, curd-like vaginal discharge), vaginal pH is 4.5, budding yeast, pseudohyphae, or mycelia visible on a wet mount, especially with potassium hydroxide (KOH). […] New oral antifungal medications to treat candidal vaginitis include ibrexafungerp and oteseconazole. Clinical use of these varies. Some experts advise treatment with these antifungals in symptomatic patients who fail topical azoles and/or oral fluconazole as documented by saline microscopy or fungal culture. […] Patients who have frequent recurrences (at least 4 documented episodes of candida vaginitis in the previous 12 months) require long-term suppression with oral medications (fluconazole 150 mg weekly to monthly or ketoconazole 100 mg once a day for 6 months).

• #80

  https://journals.lww.com/co-infectiousdiseases/fulltext/2020/02000/host_vaginal_microbiota_interactions_in_the.9.aspx

  The cause of bacterial vaginosis, the most common cause of vaginal discharge in women, remains controversial. We recently published an updated conceptual model on bacterial vaginosis pathogenesis, focusing on the roles of Gardnerella vaginalis and Prevotella bivia as early colonizers and Atopobium vaginae and other bacterial vaginosis-associated bacteria (BVAB) as secondary colonizers in this infection. […] Although G. vaginalis and P. bivia are highly abundant in women with bacterial vaginosis, neither induce a robust inflammatory response from vaginal epithelial cells. These early colonizers may be evading the immune system while establishing the bacterial vaginosis biofilm. Secondary colonizers, including A. vaginae, Sneathia spp., and potentially other BVAB are more potent stimulators of the host immune response to bacterial vaginosis and likely contribute to its signs and symptoms as well as its adverse outcomes. […] Our current bacterial vaginosis pathogenesis model provides a framework for key elements that should be considered when designing and testing novel bacterial vaginosis diagnostics and therapeutics.

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